The other day I started to experience a feeling a dread. Intense fear that I was
going to die or my son was going to die. I cannot shake this. I feel like I'm on
death row waiting to be sentence to death. I went to my doctor and she
increased some of my medication. I have no interest in things I used to. My
thoughts are "what does it matter". I am starting to pull away from my family.
Have you ever heard of this? And what did they do to pull out of this?
Thank you.

Dear Mr. P' --
You indicated "been diagnosed", I presume with bipolar disorder from the context
here; and so you're asking if I've heard of this kind of thinking in patients
with bipolar disorder? Absolutely, very commonly. There is an obvious
depressive feel to the content of these thoughts, no? So most psychiatrists I
think would regard this as depressive thinking, i.e. thinking bipolar
depression. They might even consider adding an antidepressant, and would
probably be looking at antidepressants that affect serotonin, because they would
listen to this and hear an "obsessive" component also.

As you can gather, I find such thinking frustrating to
hear because it leads toward medications that can make the manic side of things
worse, or cause "mixed states" of depressive symptoms and manic/hypomanic
symptoms together. So I would look closely in you for any other signs that this
thinking could also be somewhat "manic-side" in nature, to makes sure I didn't
make that mistake. I'd look at your sleep, which on the basis of this I'd
suspect was decreased or much more broken up (as opposed to increased, which is
what it's supposed to do in a relatively pure bipolar depression). And your
other activities; your speech rate; what your significant others might say about
how you've been acting lately (more revved up? irritable? agitated?) Only if I
found nothing along those lines would I consider an antidepressant. Otherwise,
I'd be thinking, as your psychiatrist has probably already done, about
increasing the mood stabilizers and making sure nothing else was exacerbating
cycling: sleep deprivation, alcohol, some modifiable stress source, steroid,
travel -- that kind of thing. Good luck with that.